Healthcare Provider Details

I. General information

NPI: 1831513555
Provider Name (Legal Business Name): CHARLENE JEAN BORNE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2014
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 SETTER LN
PEARL RIVER LA
70452-6311
US

IV. Provider business mailing address

148 SETTER LN
PEARL RIVER LA
70452-6311
US

V. Phone/Fax

Practice location:
  • Phone: 985-788-0691
  • Fax:
Mailing address:
  • Phone: 985-788-0691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAP07700
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: